Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

TERRE HAUTE REGIONAL HOSPITAL

Terre Haute, IN · CCN 150046 · Rates published

Your selected procedure

You selected 27447 (CPT)

Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)

This hospital’s price: $15,455 across 9 payers · range $6,693-$42,156

Source: https://core.secure.ehc.com/src/util/json-detail-price-list/35-1461805_terre-haute-regional-hospital_standardcharges.json · observed 2024-10-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

28,323 distinct procedures filed
40 distinct payers
973,162 rate rows
2026-07-17 last MRF observed
Data quality

715,339 of 973,162 rate rows are consumer-grade (73.5%)

257,823 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 204,826
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 27,730
template filing: same amount across many unrelated codes — excluded 15,377
per-diem day rate — not a per-procedure price 8,066
placeholder amount (≤ $0.02) — excluded from medians 1,591
percent-of-charges filed in the dollar field — excluded from medians 195
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 26
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 10
exceeds 10× this hospital's gross charge — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://core.secure.ehc.com/src/util/json-detail-price-list/35-1461805_terre-haute-regional-hospital_standardcharges.json
Found on page https://regionalhospital.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-11
Content fingerprint 5b9d3aca8bb05303… · 234,293,243 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 12 $3,672,900.00 $4,958,415.00 $3,682,082.25 nat. median
$3,758,972
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 13 $3,605,000.00 $4,974,900.00 $3,623,025.00 nat. median
$3,646,097
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,562,713.00 $3,562,713.00 $3,562,713.00 nat. median
$3,574,709
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 1 $3,496,850.00 $3,496,850.00 $3,496,850.00 nat. median
$3,496,850
1.0× median
J1413
HCPCS 		Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 4 $3,360,000.00 $3,696,000.00 $3,460,800.00 nat. median
$3,324,572
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 14 $5,193.41 $4,589,127.90 $3,333,768.63 nat. median
$3,325,455
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 14 $8,566.52 $4,534,680.00 $3,294,215.00 nat. median
$3,252,508
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,225,691.35 $3,225,691.35 $3,225,691.35 nat. median
$3,228,024
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,187,420.00 $3,187,420.00 $3,187,420.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 14 $7,608.77 $4,095,840.00 $2,975,420.00 nat. median
$2,939,969
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,878,960.00 $2,878,960.00 $2,878,960.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 13 $2,388,614.00 $3,296,287.32 $2,400,557.07 nat. median
$2,588,981
0.9× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,316,955.58 $2,316,955.58 $2,316,955.58 nat. median
$2,511,312
0.9× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 2 $502,693.77 $1,387,149.28 $944,921.53 nat. median
$691,418
1.4× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 2 $492,271.12 $1,345,370.55 $918,820.83 nat. median
$631,793
1.5× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 2 $445,599.57 $1,296,212.81 $870,906.19 nat. median
$588,565
1.5× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 6 $470,149.30 $1,334,154.50 $539,028.20 nat. median
$610,161
0.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 13 $529,192.90 $730,286.20 $531,838.86 nat. median
$576,820
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 13 $527,123.40 $727,430.29 $529,759.02 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 13 $526,587.60 $726,690.89 $529,220.54 nat. median
$560,872
0.9× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 6 $459,839.17 $1,315,434.06 $527,206.84 nat. median
$624,417
0.8× median
9413
OTHER 		Lisocabtagene Car Pos T 13 $516,726.10 $713,082.02 $519,309.73 nat. median
$562,201
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $513,317.11 $513,317.11 $513,317.11 nat. median
$549,535
0.9× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $511,309.70 $511,309.70 $511,309.70 nat. median
$570,020
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $510,789.97 $510,789.97 $510,789.97 nat. median
$541,339
0.9× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $501,224.32 $501,224.32 $501,224.32 nat. median
$545,335
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 13 $489,456.00 $675,449.28 $491,903.28 nat. median
$533,230
0.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $474,772.32 $474,772.32 $474,772.32 nat. median
$516,226
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 13 $460,530.40 $635,531.95 $462,833.05 nat. median
$492,768
0.9× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 6 $435,956.80 $1,191,016.00 $458,556.00 nat. median
$577,541
0.8× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $446,714.49 $446,714.49 $446,714.49 nat. median
$474,767
0.9× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 3 $390,572.37 $409,718.07 $394,401.51 nat. median
$254,667
1.5× median
24
APR_DRG 		Heart And/or Lung Transplant 3 $352,458.11 $369,735.47 $355,913.58 nat. median
$243,231
1.5× median
1614
APR_DRG 		Implantable Heart Assist Systems 3 $340,760.16 $357,464.09 $344,100.95 nat. median
$209,486
1.6× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 15 $279,263.23 $1,173,164.32 $338,055.49 nat. median
$370,165
0.9× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 15 $219,723.50 $876,256.70 $285,640.55 nat. median
$261,939
1.1× median
14
APR_DRG 		Liver Transplant And/or Intestinal Transplant 3 $256,967.42 $269,563.87 $259,486.71 nat. median
$137,901
1.9× median
74
APR_DRG 		Allogeneic Bone Marrow Transplant 3 $237,920.36 $249,583.12 $240,252.91 nat. median
$175,480
1.4× median
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 3 $233,367.73 $244,807.33 $235,655.65 nat. median
$127,600
1.8× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 3 $232,078.30 $243,454.69 $234,353.58 nat. median
$165,599
1.4× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 3 $227,160.86 $238,296.20 $229,387.93 nat. median
$168,361
1.4× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 $215,266.67 $225,818.96 $217,377.13 nat. median
$168,174
1.3× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 15 $158,958.65 $666,693.52 $209,156.13 nat. median
$199,832
1.0× median
21
APR_DRG 		Heart And/or Lung Transplant 3 $203,346.06 $213,314.00 $205,339.65 nat. median
$74,854
outlier · 2.7×
23
APR_DRG 		Heart And/or Lung Transplant 3 $203,346.06 $213,314.00 $205,339.65 nat. median
$116,111
1.8× median
22
APR_DRG 		Heart And/or Lung Transplant 3 $203,346.06 $213,314.00 $205,339.65 nat. median
$94,014
outlier · 2.2×
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 3 $203,049.17 $213,002.57 $205,039.85 nat. median
$156,285
1.3× median
5834
APR_DRG 		Neonate With Ecmo 3 $192,625.56 $202,067.99 $194,514.04 nat. median
$311,018
0.6× median
5832
APR_DRG 		Neonate With Ecmo 3 $192,625.56 $202,067.99 $194,514.04 nat. median
$169,230
1.1× median
5833
APR_DRG 		Neonate With Ecmo 3 $192,625.56 $202,067.99 $194,514.04 nat. median
$250,089
0.8× median

Other procedures at this hospital

Browse this hospital's 28,323 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
9138 OTHER Inj, Hemgenix, Per Tx Dos 32 12 — — $3,672,900.00 $4,958,415.00 $3,682,082.25 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 34 13 $3,170.49 — $3,605,000.00 $4,974,900.00 $3,623,025.00 2026-07-17
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 1 — — $3,562,713.00 $3,562,713.00 $3,562,713.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 2 1 — — $3,496,850.00 $3,496,850.00 $3,496,850.00 2024-10-01
J1413 HCPCS Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 10 4 — — $3,360,000.00 $3,696,000.00 $3,460,800.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 36 14 $28,122.21 — $5,193.41 $4,589,127.90 $3,333,768.63 2026-07-17
748 OTHER Inj, Lovotibeglogene Auto 36 14 $41,593.40 — $8,566.52 $4,534,680.00 $3,294,215.00 2026-07-17
00714 OTHER Inj Delandistrogene Mox R 2 1 — — $3,225,691.35 $3,225,691.35 $3,225,691.35 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 2 1 — — $3,187,420.00 $3,187,420.00 $3,187,420.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 36 14 $45,884.23 — $7,608.77 $4,095,840.00 $2,975,420.00 2026-07-17
00746 OTHER Inj, Betibeglogene Autote 2 1 — — $2,878,960.00 $2,878,960.00 $2,878,960.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 34 13 — — $2,388,614.00 $3,296,287.32 $2,400,557.07 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 1 — — $2,316,955.58 $2,316,955.58 $2,316,955.58 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 2 $1,241,369.98 — $502,693.77 $1,387,149.28 $944,921.53 2026-07-17
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 2 $1,306,185.00 — $492,271.12 $1,345,370.55 $918,820.83 2026-07-17
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 2 $1,190,501.53 — $445,599.57 $1,296,212.81 $870,906.19 2026-07-17
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 14 6 $1,178,375.50 — $470,149.30 $1,334,154.50 $539,028.20 2026-07-17
9194 OTHER Tisagenlecleucel Car-pos 34 13 $612,706.41 — $529,192.90 $730,286.20 $531,838.86 2026-07-17
9498 OTHER Ciltacabtagene Car-pos T 34 13 $646,582.50 — $527,123.40 $727,430.29 $529,759.02 2026-07-17
9422 OTHER Idecabtagene Vicleucel Ca 34 13 $600,304.50 — $526,587.60 $726,690.89 $529,220.54 2026-07-17
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 14 6 $1,152,532.70 — $459,839.17 $1,315,434.06 $527,206.84 2026-07-17
9413 OTHER Lisocabtagene Car Pos T 34 13 $587,139.30 — $516,726.10 $713,082.02 $519,309.73 2026-07-17
09194 OTHER Tisagenlecleucel Car-pos 2 1 — — $513,317.11 $513,317.11 $513,317.11 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 2 1 — — $511,309.70 $511,309.70 $511,309.70 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 2 1 — — $510,789.97 $510,789.97 $510,789.97 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 2 1 — — $501,224.32 $501,224.32 $501,224.32 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 34 13 $570,894.44 — $489,456.00 $675,449.28 $491,903.28 2026-07-17
09035 OTHER Axicabtagene Ciloleucel C 2 1 — — $474,772.32 $474,772.32 $474,772.32 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 34 13 $570,969.00 — $460,530.40 $635,531.95 $462,833.05 2026-07-17
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 14 6 $1,189,193.86 — $435,956.80 $1,191,016.00 $458,556.00 2026-07-17
09391 OTHER Brexucabtagene Car Pos T 2 1 — — $446,714.49 $446,714.49 $446,714.49 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 3 — — $390,572.37 $409,718.07 $394,401.51 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 8 3 — — $352,458.11 $369,735.47 $355,913.58 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 8 3 — — $340,760.16 $357,464.09 $344,100.95 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 52 15 — — $279,263.23 $1,173,164.32 $338,055.49 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 52 15 — — $219,723.50 $876,256.70 $285,640.55 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 8 3 — — $256,967.42 $269,563.87 $259,486.71 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 8 3 — — $237,920.36 $249,583.12 $240,252.91 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 3 — — $233,367.73 $244,807.33 $235,655.65 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 3 — — $232,078.30 $243,454.69 $234,353.58 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 3 — — $227,160.86 $238,296.20 $229,387.93 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 3 — — $215,266.67 $225,818.96 $217,377.13 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 54 15 — — $158,958.65 $666,693.52 $209,156.13 2024-10-01
22 APR_DRG Heart And/or Lung Transplant 8 3 — — $203,346.06 $213,314.00 $205,339.65 2024-10-01
21 APR_DRG Heart And/or Lung Transplant 8 3 — — $203,346.06 $213,314.00 $205,339.65 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 8 3 — — $203,346.06 $213,314.00 $205,339.65 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 3 — — $203,049.17 $213,002.57 $205,039.85 2024-10-01
5831 APR_DRG Neonate With Ecmo 8 3 — — $192,625.56 $202,067.99 $194,514.04 2024-10-01
5832 APR_DRG Neonate With Ecmo 8 3 — — $192,625.56 $202,067.99 $194,514.04 2024-10-01
5834 APR_DRG Neonate With Ecmo 8 3 — — $192,625.56 $202,067.99 $194,514.04 2024-10-01
5833 APR_DRG Neonate With Ecmo 8 3 — — $192,625.56 $202,067.99 $194,514.04 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 54 15 — — $13,168.00 $738,016.31 $194,416.11 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 8 3 — — $184,515.37 $193,560.24 $186,324.34 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 3 — — $182,513.92 $191,460.68 $184,303.27 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 1 $826,059.89 — $176,035.11 $176,035.11 $176,035.11 2026-07-17
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 3 — — $170,992.09 $179,374.05 $172,668.48 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 3 — — $170,992.09 $179,374.05 $172,668.48 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 3 — — $170,992.09 $179,374.05 $172,668.48 2024-10-01
64 APR_DRG Pancreas Transplant 8 3 — — $165,093.42 $173,186.24 $166,711.99 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 8 3 — — $164,178.87 $172,226.86 $165,788.47 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 3 — — $161,069.15 $168,964.69 $162,648.26 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 3 — — $151,600.34 $159,031.73 $153,086.62 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $145,172.06 $152,288.34 $146,595.32 2024-10-01
1908 OTHER New Technology - Level 52 34 13 $189,483.85 — $144,988.30 $200,083.85 $145,713.24 2026-07-17
1907 OTHER New Technology - Level 52 34 13 $189,483.85 — $144,988.30 $200,083.85 $145,713.24 2026-07-17
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 1 $1,060,825.47 — $145,254.98 $145,254.98 $145,254.98 2026-07-17
73 APR_DRG Allogeneic Bone Marrow Transplant 8 3 — — $143,599.59 $150,638.79 $145,007.43 2024-10-01
72 APR_DRG Allogeneic Bone Marrow Transplant 8 3 — — $143,599.59 $150,638.79 $145,007.43 2024-10-01
71 APR_DRG Allogeneic Bone Marrow Transplant 8 3 — — $143,599.59 $150,638.79 $145,007.43 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $141,303.78 $148,230.43 $142,689.11 2024-10-01
01908 OTHER New Technology - Level 52 2 1 — — $140,638.65 $140,638.65 $140,638.65 2024-10-01
01907 OTHER New Technology - Level 52 2 1 — — $140,638.65 $140,638.65 $140,638.65 2024-10-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 8 3 — — $134,683.03 $141,285.14 $136,003.46 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $134,147.13 $140,722.97 $135,462.30 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 3 — — $133,930.76 $140,496.00 $135,243.81 2024-10-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 3 — — $133,930.76 $140,496.00 $135,243.81 2024-10-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 3 — — $133,930.76 $140,496.00 $135,243.81 2024-10-01
4404 APR_DRG Kidney Transplant 8 3 — — $130,383.26 $136,774.60 $131,661.53 2024-10-01
1905 OTHER New Technology - Level 51 34 13 $170,846.16 — $130,727.20 $180,403.54 $131,380.84 2026-07-17
1906 OTHER New Technology - Level 51 34 13 $170,846.16 — $130,727.20 $180,403.54 $131,380.84 2026-07-17
14 MS_DRG Allogeneic Bone Marrow Transplant 50 15 — — $102,534.20 $407,569.00 $128,167.75 2024-10-01
7 MS_DRG Lung Transplant 50 15 — — $102,277.50 $406,542.37 $127,846.88 2024-10-01
01906 OTHER New Technology - Level 51 2 1 — — $126,805.38 $126,805.38 $126,805.38 2024-10-01
01905 OTHER New Technology - Level 51 2 1 — — $126,805.38 $126,805.38 $126,805.38 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 3 — — $124,406.60 $130,504.96 $125,626.27 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 3 — — $123,900.89 $129,974.47 $125,115.61 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 $125,543.70 — $123,321.96 $123,321.96 $123,321.96 2026-07-17
8634 APR_DRG Neonatal Aftercare 8 3 — — $121,027.67 $126,960.40 $122,214.21 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 1 $593,938.65 — $117,908.35 $117,908.35 $117,908.35 2026-07-17
1904 OTHER New Technology - Level 50 34 13 $152,208.46 — $116,466.10 $160,723.22 $117,048.43 2026-07-17
1903 OTHER New Technology - Level 50 34 13 $152,208.46 — $116,466.10 $160,723.22 $117,048.43 2026-07-17
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 3 — — $115,120.20 $120,763.35 $116,248.83 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 54 15 — — $13,168.00 $439,556.30 $116,058.81 2024-10-01
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 3 — — $114,586.81 $120,203.82 $115,710.21 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 3 — — $114,586.81 $120,203.82 $115,710.21 2024-10-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 3 — — $114,586.81 $120,203.82 $115,710.21 2024-10-01
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 3 — — $113,248.32 $118,799.71 $114,358.60 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 3 — — $113,248.32 $118,799.71 $114,358.60 2024-10-01
6091 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 3 — — $113,248.32 $118,799.71 $114,358.60 2024-10-01
63 APR_DRG Pancreas Transplant 8 3 — — $113,206.81 $118,756.17 $114,316.68 2024-10-01
61 APR_DRG Pancreas Transplant 8 3 — — $113,206.81 $118,756.17 $114,316.68 2024-10-01
62 APR_DRG Pancreas Transplant 8 3 — — $113,206.81 $118,756.17 $114,316.68 2024-10-01
01903 OTHER New Technology - Level 50 2 1 — — $112,972.12 $112,972.12 $112,972.12 2024-10-01
01904 OTHER New Technology - Level 50 2 1 — — $112,972.12 $112,972.12 $112,972.12 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 52 15 — — $86,345.31 $442,340.00 $112,248.90 2024-10-01
84 APR_DRG Autologous Bone Marrow Transplant 8 3 — — $105,041.27 $110,190.35 $106,071.08 2024-10-01
104 APR_DRG Head Trauma With Deep Coma 8 3 — — $104,836.22 $109,975.25 $105,864.02 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 3 — — $103,902.80 $108,996.07 $104,921.45 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 3 — — $103,902.80 $108,996.07 $104,921.45 2024-10-01
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 3 — — $103,902.80 $108,996.07 $104,921.45 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 50 15 — — $83,458.66 $331,277.95 $104,323.33 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 8 3 — — $103,078.82 $108,131.70 $104,089.40 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $102,398.25 $107,417.78 $103,402.16 2024-10-01
1901 OTHER New Technology - Level 49 34 13 $133,570.77 — $102,205.00 $141,042.90 $102,716.02 2026-07-17
1902 OTHER New Technology - Level 49 34 13 $133,570.77 — $102,205.00 $141,042.90 $102,716.02 2026-07-17
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 54 15 — — $78,051.64 $326,082.58 $102,699.52 2024-10-01
J9999 HCPCS Carmustine Wafers 8/box 24 21 $155,513.00 $155,513.00 $52,096.86 $139,961.70 $102,638.58 2024-10-01
5931 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 3 — — $101,487.48 $106,462.35 $102,482.45 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 3 — — $101,487.48 $106,462.35 $102,482.45 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 8 3 — — $100,766.65 $105,706.20 $101,754.56 2024-10-01
3031 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 3 — — $100,491.16 $105,417.19 $101,476.36 2024-10-01
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 3 — — $100,491.16 $105,417.19 $101,476.36 2024-10-01
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 3 — — $100,491.16 $105,417.19 $101,476.36 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 46 16 $128,527.25 — $72,648.53 $137,999.86 $99,999.90 2026-07-17
01902 OTHER New Technology - Level 49 2 1 — — $99,138.85 $99,138.85 $99,138.85 2024-10-01
01901 OTHER New Technology - Level 49 2 1 — — $99,138.85 $99,138.85 $99,138.85 2024-10-01
102 APR_DRG Head Trauma With Deep Coma 8 3 — — $97,305.95 $102,075.85 $98,259.93 2024-10-01
103 APR_DRG Head Trauma With Deep Coma 8 3 — — $97,305.95 $102,075.85 $98,259.93 2024-10-01
101 APR_DRG Head Trauma With Deep Coma 8 3 — — $97,305.95 $102,075.85 $98,259.93 2024-10-01
215 MS_DRG Other Heart Assist System Implant 56 16 — — $61,672.00 $329,585.56 $97,730.30 2024-10-01
J1412 HCPCS Injection, Valoctocogene Roxaparvovec-rvox, Per Ml, Containing Nominal 2 X 10°13… 12 5 — — $31,820.70 $104,671.88 $97,535.16 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $95,169.90 $99,835.10 $96,102.94 2024-10-01
6021 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $95,169.90 $99,835.10 $96,102.94 2024-10-01
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $94,440.28 $99,069.70 $95,366.16 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 3 — — $94,220.13 $98,838.76 $95,143.86 2024-10-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 8 3 — — $92,817.48 $97,367.36 $93,727.46 2024-10-01
8633 APR_DRG Neonatal Aftercare 8 3 — — $91,192.17 $95,662.38 $92,086.22 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 36 14 — — $88,300.94 $125,624.02 $91,259.48 2024-10-01
1599 OTHER New Technology - Level 48 34 13 $118,039.36 — $90,320.77 $124,642.66 $90,772.37 2026-07-17
1585 OTHER New Technology - Level 48 34 13 $118,039.36 — $90,320.77 $124,642.66 $90,772.37 2026-07-17
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $89,564.35 $93,954.76 $90,442.43 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 54 15 — — $13,168.00 $338,884.34 $89,628.57 2024-10-01
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 8 3 — — $88,191.89 $92,515.03 $89,056.52 2024-10-01
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 8 3 — — $86,955.30 $91,217.82 $87,807.80 2024-10-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 8 3 — — $86,955.30 $91,217.82 $87,807.80 2024-10-01
01599 OTHER New Technology - Level 48 2 1 — — $87,611.15 $87,611.15 $87,611.15 2024-10-01
01585 OTHER New Technology - Level 48 2 1 — — $87,611.15 $87,611.15 $87,611.15 2024-10-01
312754 CDM Ins Icd Lead/generator 25 22 $123,935.00 $123,935.00 $41,518.22 $123,935.00 $86,754.50 2024-10-01
312757 CDM Ins Icd Lead/generator 25 22 $123,935.00 $123,935.00 $41,518.22 $123,935.00 $86,754.50 2024-10-01
1204 APR_DRG Major Respiratory And Chest Procedures 8 3 — — $84,960.15 $89,124.86 $85,793.09 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 3 — — $84,732.45 $88,886.00 $85,563.16 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 3 — — $84,732.45 $88,886.00 $85,563.16 2024-10-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 8 3 — — $84,667.04 $88,817.38 $85,497.11 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 56 16 — — $71,909.31 $300,223.94 $85,164.90 2024-10-01
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 8 3 — — $83,816.64 $87,925.30 $84,638.37 2024-10-01
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 3 — — $83,532.34 $87,627.06 $84,351.28 2024-10-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 8 3 — — $83,188.91 $87,266.80 $84,004.49 2024-10-01
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 3 — — $82,728.49 $86,783.81 $83,539.55 2024-10-01
11 APR_DRG Liver Transplant And/or Intestinal Transplant 8 3 — — $82,478.15 $86,521.20 $83,286.76 2024-10-01
12 APR_DRG Liver Transplant And/or Intestinal Transplant 8 3 — — $82,478.15 $86,521.20 $83,286.76 2024-10-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 8 3 — — $82,478.15 $86,521.20 $83,286.76 2024-10-01
326644 CDM Rm/ins Icd Gen Sgl Ld 25 22 $118,672.00 $118,672.00 $39,755.12 $118,672.00 $83,070.40 2024-10-01
333391 CDM Insrt Rpl Perm Defib Sys 25 22 $118,672.00 $118,672.00 $39,755.12 $118,672.00 $83,070.40 2024-10-01
326647 CDM Rv/ins Icd Gen Mlt Lead 25 22 $118,672.00 $118,672.00 $39,755.12 $118,672.00 $83,070.40 2024-10-01
326646 CDM Rv/ins Icd Gen Duel Ld 25 22 $118,672.00 $118,672.00 $39,755.12 $118,672.00 $83,070.40 2024-10-01
326643 CDM Ins Icd Gen Exs Mult Ld 25 22 $118,672.00 $118,672.00 $39,755.12 $118,672.00 $83,070.40 2024-10-01
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 8 3 — — $82,205.17 $86,234.84 $83,011.10 2024-10-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 8 3 — — $82,144.79 $86,171.49 $82,950.13 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 1 $403,011.66 — $82,904.22 $82,904.22 $82,904.22 2026-07-17
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 8 3 — — $81,684.37 $85,688.50 $82,485.19 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 54 15 — — $62,225.83 $259,457.40 $81,876.09 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 56 16 — — $38,999.00 $263,607.47 $81,509.71 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 8 3 — — $80,645.28 $84,598.48 $81,435.92 2024-10-01
1694 APR_DRG Major Abdominal Vascular Procedures 8 3 — — $80,535.83 $84,483.67 $81,325.40 2024-10-01
1584 OTHER New Technology - Level 47 34 13 $105,614.23 — $80,813.38 $111,522.46 $81,217.45 2026-07-17
1598 OTHER New Technology - Level 47 34 13 $105,614.23 — $80,813.38 $111,522.46 $81,217.45 2026-07-17
312704 CDM Upgrade Pacer System 25 22 $115,422.00 $115,422.00 $38,666.37 $115,422.00 $80,795.40 2024-10-01
312705 CDM Upgrade Pacer System 25 22 $115,422.00 $115,422.00 $38,666.37 $115,422.00 $80,795.40 2024-10-01
894 APR_DRG Major Cranial Or Facial Bone Procedures 8 3 — — $79,856.52 $83,771.06 $80,639.43 2024-10-01
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $79,793.62 $83,705.08 $80,575.91 2024-10-01
6954 APR_DRG Chemotherapy For Acute Leukemia 8 3 — — $79,490.45 $83,387.04 $80,269.77 2024-10-01
4414 APR_DRG Major Bladder Procedures 8 3 — — $79,289.17 $83,175.90 $80,066.52 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 56 16 — — $58,352.14 $243,149.54 $79,850.30 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 56 16 — — $57,769.83 $240,698.07 $78,504.97 2024-10-01
01598 OTHER New Technology - Level 47 2 1 — — $78,388.98 $78,388.98 $78,388.98 2024-10-01
01584 OTHER New Technology - Level 47 2 1 — — $78,388.98 $78,388.98 $78,388.98 2024-10-01
10 MS_DRG Pancreas Transplant 50 15 — — $62,643.00 $248,027.59 $78,303.75 2024-10-01
6904 APR_DRG Acute Leukemia 8 3 — — $77,246.22 $81,032.80 $78,003.53 2024-10-01
4403 APR_DRG Kidney Transplant 8 3 — — $76,770.70 $80,533.97 $77,523.35 2024-10-01
1814 APR_DRG Lower Extremity Vascular Procedures 8 3 — — $76,364.37 $80,107.72 $77,113.04 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 2 1 $328,503.36 — $77,032.29 $77,032.29 $77,032.29 2026-07-17
2304 APR_DRG Major Small Bowel Procedures 8 3 — — $75,800.80 $79,516.52 $76,543.94 2024-10-01
214 APR_DRG Open Craniotomy Except Trauma 8 3 — — $75,604.55 $79,310.66 $76,345.77 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 54 15 — — $13,168.00 $286,563.54 $75,892.33 2024-10-01
1324 APR_DRG Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period 8 3 — — $74,881.22 $78,551.86 $75,615.35 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 8 3 — — $74,735.29 $78,398.78 $75,467.99 2024-10-01
6903 APR_DRG Acute Leukemia 8 3 — — $74,624.59 $78,282.66 $75,356.20 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 1 $104,077.42 — $75,018.18 $75,018.18 $75,018.18 2026-07-17
6031 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 3 — — $73,990.57 $77,617.55 $74,715.96 2024-10-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 8 3 — — $73,628.27 $77,237.50 $74,350.11 2024-10-01
3043 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 8 3 — — $73,042.05 $76,622.54 $73,758.15 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 54 15 — — $55,750.22 $232,195.71 $73,355.55 2024-10-01
6224 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 8 3 — — $72,470.93 $76,023.42 $73,181.43 2024-10-01
371977 CDM Set Vntrc 17.4x13.8in 26 22 $107,999.00 $107,999.00 $36,179.67 $107,999.00 $72,521.33 2024-10-01
916932 CDM Set Pump Asst 2.5in 26 22 $107,999.00 $107,999.00 $36,179.67 $107,999.00 $72,521.33 2024-10-01
916793 CDM Cath Pmp Impella 5.0 9f 26 22 $107,999.00 $107,999.00 $36,179.67 $107,999.00 $72,521.33 2024-10-01
6112 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 8 3 — — $71,663.30 $75,176.21 $72,365.89 2024-10-01
1214 APR_DRG Other Respiratory And Chest Procedures 8 3 — — $71,547.57 $75,054.80 $72,249.02 2024-10-01
1583 OTHER New Technology - Level 46 34 13 $93,189.10 — $71,305.98 $98,402.25 $71,662.51 2026-07-17
1597 OTHER New Technology - Level 46 34 13 $93,189.10 — $71,305.98 $98,402.25 $71,662.51 2026-07-17
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 52 15 — — $59,171.66 $246,599.64 $71,628.85 2024-10-01
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 8 3 — — $70,678.31 $74,142.93 $71,371.23 2024-10-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 8 3 — — $70,092.09 $73,527.98 $70,779.27 2024-10-01
83 APR_DRG Autologous Bone Marrow Transplant 8 3 — — $70,080.77 $73,516.10 $70,767.83 2024-10-01
81 APR_DRG Autologous Bone Marrow Transplant 8 3 — — $70,080.77 $73,516.10 $70,767.83 2024-10-01
82 APR_DRG Autologous Bone Marrow Transplant 8 3 — — $70,080.77 $73,516.10 $70,767.83 2024-10-01
55865 CPT Exposure Of Prostate, Any Approach, For Insertion Of Radioactive Substance; With… 12 2 $70,326.00 — $37,516.00 $70,326.00 $70,326.00 2026-07-17
55862 CPT Exposure Of Prostate, Any Approach, For Insertion Of Radioactive Substance; With… 12 2 $70,326.00 — $37,516.00 $70,326.00 $70,326.00 2026-07-17
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 8 3 — — $69,543.61 $72,952.61 $70,225.41 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 56 16 — — $52,173.00 $263,458.15 $69,943.13 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 54 15 — — $53,052.97 $220,840.56 $69,806.54 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 54 15 — — $52,815.02 $219,838.81 $69,493.45 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 8 3 — — $68,674.35 $72,040.74 $69,347.62 2024-10-01
01597 OTHER New Technology - Level 46 2 1 — — $69,166.80 $69,166.80 $69,166.80 2024-10-01
01583 OTHER New Technology - Level 46 2 1 — — $69,166.80 $69,166.80 $69,166.80 2024-10-01
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 8 3 — — $67,869.24 $71,196.16 $68,534.62 2024-10-01
1764 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 8 3 — — $67,695.64 $71,014.05 $68,359.32 2024-10-01
1763 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 8 3 — — $67,695.64 $71,014.05 $68,359.32 2024-10-01
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 8 3 — — $67,675.51 $70,992.94 $68,339.00 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 56 16 — — $26,086.00 $250,762.15 $68,276.54 2024-10-01
326035 CDM Stnt Fempop W/ath/plsty 25 22 $97,495.00 $97,495.00 $32,660.83 $97,495.00 $68,246.50 2024-10-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 8 3 — — $66,545.84 $69,807.90 $67,198.26 2024-10-01
4402 APR_DRG Kidney Transplant 8 3 — — $66,538.30 $69,799.98 $67,190.63 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 54 15 — — $51,051.84 $212,415.97 $67,173.48 2024-10-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 8 3 — — $66,464.08 $69,722.12 $67,115.68 2024-10-01
234 APR_DRG Spinal Procedures 8 3 — — $66,228.83 $69,475.35 $66,878.14 2024-10-01
2644 APR_DRG Other Hepatobiliary, Pancreas And Abdominal Procedures 8 3 — — $65,958.37 $69,191.62 $66,605.02 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 3 — — $65,892.95 $69,123.00 $66,538.96 2024-10-01
5894 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 3 — — $65,892.95 $69,123.00 $66,538.96 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 3 — — $65,892.95 $69,123.00 $66,538.96 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 3 — — $65,892.95 $69,123.00 $66,538.96 2024-10-01
335039 CDM Thrmbc Dia Cir Stent Plc 25 22 $95,021.00 $95,021.00 $31,832.03 $95,021.00 $66,514.70 2024-10-01
007 OTHER Lung Transplant 2 1 $358,272.05 — $66,464.84 $66,464.84 $66,464.84 2026-07-17
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 56 16 — — $44,862.95 $225,051.00 $66,349.95 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 1 $430,795.00 — $66,344.28 $66,344.28 $66,344.28 2026-07-17
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 36 14 — — $63,895.55 $90,902.95 $66,036.38 2024-10-01
C1822 HCPCS Pulse Gen Imp 24 21 $100,000.00 $100,000.00 $33,500.00 $90,000.00 $66,000.00 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 54 15 — — $50,137.73 $208,567.66 $65,970.70 2024-10-01
1754 APR_DRG Percutaneous Cardiac Intervention Without Ami 8 3 — — $65,294.16 $68,494.85 $65,934.29 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 34 13 $80,721.67 — $65,476.58 $90,357.68 $65,803.96 2026-07-17
4401 APR_DRG Kidney Transplant 8 3 — — $64,968.34 $68,153.06 $65,605.28 2024-10-01
96927 CDM Insrt Perm Pcmkr Ldless 25 22 $93,662.00 $93,662.00 $31,376.77 $93,662.00 $65,563.40 2024-10-01
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 8 3 — — $63,877.67 $67,008.93 $64,503.92 2024-10-01
C2624 HCPCS Sensor Artery Impl Systm 25 21 $100,000.00 $100,000.00 $33,500.00 $90,000.00 $64,300.00 2024-10-01
914 APR_DRG Other Major Head And Neck Procedures 8 3 — — $63,597.14 $66,714.65 $64,220.64 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 36 14 $51,956.53 — $12,445.84 $87,429.58 $63,513.15 2026-07-17
01643 OTHER Y90 Ibritumomab, Rx 2 1 — — $63,512.28 $63,512.28 $63,512.28 2024-10-01
6082 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 8 3 — — $62,615.92 $65,685.33 $63,229.80 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 14 3 — — $56,700.00 $168,273.22 $63,000.00 2024-10-01
204 APR_DRG Open Craniotomy For Trauma 8 3 — — $62,113.98 $65,158.79 $62,722.94 2024-10-01
4034 APR_DRG Procedures For Obesity 8 3 — — $62,111.47 $65,156.15 $62,720.40 2024-10-01
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 8 3 — — $62,032.22 $65,073.01 $62,640.37 2024-10-01
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 3 — — $61,818.36 $64,848.67 $62,424.42 2024-10-01
51 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 3 — — $61,818.36 $64,848.67 $62,424.42 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 56 16 — — $44,557.75 $185,076.50 $62,313.32 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 56 16 — — $47,998.00 $200,889.71 $62,299.57 2024-10-01
1582 OTHER New Technology - Level 45 34 13 $80,763.97 — $61,798.57 $85,282.03 $62,107.56 2026-07-17
1596 OTHER New Technology - Level 45 34 13 $80,763.97 — $61,798.57 $85,282.03 $62,107.56 2026-07-17
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 8 3 — — $61,142.82 $64,140.02 $61,742.26 2024-10-01
6143 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 8 3 — — $61,142.82 $64,140.02 $61,742.26 2024-10-01
79575 CDM Evas Rpr Dt Aorta W Lsao 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
312703 CDM Repl Gen Atr/vent Dual 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
79576 CDM Evas Rpr Dt Aorta No Lsa 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
312746 CDM Ins Icd Generator 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
312743 CDM Ins Icd Generator 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
312702 CDM Repl Gen Atr/vent Dual 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80329 CDM Evas Rpr Infr Ao Nonrupt 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
312689 CDM Ppm Vent 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80338 CDM Evas Rpr Iliac Nonrupt 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
312691 CDM Ppm Atr/vent 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
312692 CDM Ppm Atr/vent 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
79570 CDM Ext Prosth Dt Aorta Ini 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
312688 CDM Ppm Vent 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80333 CDM Evas Rpr Ao/il Rupt Uni 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
79574 CDM Rpr Aorta W Open Trnsp 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80336 CDM Evas Rpr Ao/il Rupt Bi 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80342 CDM Evas Rpr Prosthesis Addl 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80345 CDM Evas Rpr Delayd Ext Intl 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
312686 CDM Ppm Atrial 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80332 CDM Evas Rpr Ao/il Nonrupt 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
79572 CDM Rpr Aorta Prox Ext Addl 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
326639 CDM Remv Gen Atr/vent Mult 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80339 CDM Evas Rpr Iliac Art Rupt 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80346 CDM Evas Rpr Delayd Ext Addl 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
79573 CDM Rpr Aorta Plc Dist Ext 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80334 CDM Evas Rpr Ao/il Nonrup Bi 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
323222 CDM Endovasc Repair Aaa 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
80330 CDM Evas Rpr Infrn Ao Rupt 25 22 $88,182.00 $88,182.00 $29,540.97 $88,182.00 $61,727.40 2024-10-01
3174 APR_DRG Tendon, Muscle And Other Soft Tissue Procedures 8 3 — — $61,018.28 $64,009.38 $61,616.50 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 2 1 — — $61,454.13 $61,454.13 $61,454.13 2024-10-01
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